Kentucky health insurance

Kentucky an ACA 'success story' despite residents' skepticism

While many Kentucky residents are deeply skeptical of Obamacare, the state is touted as an ACA success story. Use this brief summary to understand where Kentucky has been in terms of public health and insured rates – and learn how the Affordable Care Act is shaping the future of these important quality-of-life measures.

Kentucky health ratings

Kentucky ranks 42nd in the Commonwealth Fund’s 2014 Scorecard on State Health System Performance, down from 40th in 2009. The evaluation compares more than 40 measures to arrive at an overall health score for each of the 50 states and the District of Columbia. See Kentucky’s Scorecard to see its performance on specific measures.

Kentucky also ranks among the bottom 20 percent of states in America’s Health Rankings, which are compiled by the United Health Foundation. Kentucky was ranked 45th in 2013, down from 43rd in 2012. Kentucky has low rates of binge drinking, violent crime, and infectious disease.

However, those positives are countered by the nation’s highest smoking rate – more than one in four adults in Kentucky is a smoker – and high rates of cancer deaths and preventable hospitalizations.

Kentucky and the Affordable Care Act

In 2010 passage of the Affordable Care Act, Kentucky’s two Republican senators voted “no.” Kentucky’s current senators remain firmly opposed to the ACA. Mitch McConnell was re-elected to the U.S. Senate in the 2014 election and will take over as majority leader in January 2015. Shortly after his re-election, McConnell joined House Speaker John Boehner in vowing to continue efforts to repeal the ACA. Former Sen. Jim Bunning was replaced by Sen. Rand Paul, who says he would not have voted for the ACA and is in favor of seeing the law repealed.

Kentucky’s representatives in the House split their votes on the ACA along party lines, with two yes votes and four no votes.

At the state level, Gov. Steve Beshear’s support of the ACA has repeatedly drawn national attention, with even President Obama making note of it during his 2014 State of the Union address. Beshear used an executive order to establish Kentucky’s state-run health insurance marketplace, Kynect.

Kynect is viewed as a model for state-run marketplaces. Beshear also fully supported Medicaid expansion, calling it the “single most important decision” for improving the health of Kentucky residents.

How did the ACA help Kentucky?

Kentucky made the headline of Gallup’s findings about the drop in the nation’s uninsured rate after the Affordable Care Act’s individual mandate went into effect. Kentucky saw the nation’s second largest drop, going from an uninsured rate of 20.4 percent in 2013 to 11.9 percent in mid-2014. Only Arkansas, with a 10.1 percentage point decrease, experienced a greater decline in its uninsured population.

Kentucky enrollment in QHPs

Nearly 83,000 Kentucky residents signed up for qualified health plans (QHPs) during the 2014 open enrollment period. That’s 27.4 percent of the estimated eligible market of 302,000 people. For comparison, Vermont led the nation with a sign-up rate of 85.2 percent of its eligible residents, and the national average of 28 percent.

Kentucky Medicaid/CHIP

In addition to implementing a state-run health insurance exchange, Kentucky expanded Medicaid under the Affordable Care Act. Under the expansion, Kentucky residents with household income up to 138 percent of the federal poverty level ($16,105 a year for one person or $32,913 for a family of four) are eligible for Medicaid.

About 358,000 Kentucky residents were deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) during the ACA’s initial open enrollment period. Enrollment in Medicaid and CHIP continues throughout the year.

Does Kentucky have a high-risk pool?

Before the ACA reformed the individual health insurance market, pre-existing conditions were a barrier to obtaining coverage in nearly all states, including Kentucky. Medical histories were scrutinized during the application process, and people who didn’t meet the health eligibility guidelines were unable to purchase private coverage.

Kentucky Access was established in 2001 to offer coverage to people who were not able to get policies in the individual market because of pre-existing conditions.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This aspect of reform largely eliminated the need for high risk pools, and Kentucky Access notified their members last September that the plan would cease operations at the end of 2013. Insureds were able to transition to private coverage through Kynect instead.

Other ACA reform provisions

The ACA established a federal loan program to encourage the creation of Consumer Operated and Oriented Plans (CO-OPs), which are nonprofit, consumer-run health insurance companies. Through the program, 24 CO-OPs were set up as of January 2014, including the Kentucky Health Care Cooperative. See all the states where CO-OPs were established.

Kentucky’s state-based reform legislation

Here’s what’s happening legislatively in Kentucky with healthcare reform at the state level: